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August 1, 2012 -- Dentists in Arizona can administer Botox and dermal fillers as long as it is part of a dental treatment plan, according to a Substantive Policy Statement update issued in June by the Arizona State Board of Dental Examiners.

According to the updated statement, "a dentist may inject pharmacological agents such as Botulinum, Toxin Type A, or dermal fillers as supportive therapy in conjunction with a dental treatment plan consistent with the scope of practice."

The statement also makes it clear that such agents cannot not be administered outside a dental treatment plan.

"The bottom line is that Botox and dermal fillers are allowed within the scope of dental practice for use by general dentists for dental aesthetic and dental therapeutic uses with appropriate training," stated Louis Malcmacher, DDS, president of the American Academy of Facial Esthetics (AAFE), in a press release.

However, Kevin Earle, MPH, executive director of the Arizona Dental Association (AzDA), told DrBicuspid.com that the change should not be interpreted too broadly. The AzDA participated in the stakeholders committee that drafted the revised substantive policy statement.

"The dental board has adopted a change in its Substantive Policy Statement that identifies a safe harbor for dentists to use these pharmacological agents, but there have been no changes in regulations or laws," Earle said.

It was not explicitly stated before that dentists can administer these pharmacological agents for therapeutic purposes and now it is, he noted.

"Dentists can now use Botox and dermal fillers as part of a dental treatment plan, but this does not open the door for dentists to routinely offer Botox," Earle said. For example, if a patient presents with wrinkles around the forehead and crow's feet and asks if his dentist can give Botox, the answer is no, he noted.

While Dr. Malcmacher emphasized the importance of proper training, "the board document does not speak to training at all as that would start a whole other debate," Earle said. "Once you require training for one procedure, you will have to do it for all of them."

For example, there is no additional training required in law or regulations to do implants, he explained.

Aesthetic effects

Overall, the policy statement addresses the use of these pharmacological agents but still keeps the use pretty limited, Earle emphasized.

"We have an acceptance that the use of these agents has become common in dentistry and that is why their regular use has to evolve too," he said. "We need to be adaptive."

Dr. Malcmacher maintains that the AAFE's interpretation of the policy update is accurate: Dentists can now do Botox and dermal fillers for dental aesthetics and dental therapeutics within the scope of dentistry.

"When dentists treat patients using Botox for facial pain, they inject in the same area and at the same dosage as for aesthetic reasons," he explained. "It is physically impossible to separate the therapeutic and aesthetic uses of Botox."

When the AAFE trains dentists to do Botox for therapeutic purposes, they are also trained about the aesthetic outcomes; otherwise, the patient treatment may be detrimental to the final outcome, Dr. Malcmacher noted.

"If you don't take the aesthetic effects into consideration, your patient could end up with a crooked face and they will not come back," he said.

As for training, he maintains that dentists would be foolish to do Botox or dermal fillers without proper training.

"Just because the board does not require training does not mean they do not need it," he said. "If dentists have inadequate or no training and something goes wrong, they could lose their license."

Dentists should be allowed to do Botox for purely cosmetic purposes since this is already allowed in many states and general dentists have been doing this for the last few years, Dr. Malcmacher argues. The AAFE has worked with multiple dental boards to train dentists on the use of Botox and dermal fillers, he noted; they have so far trained nearly 7,000 dental professionals through lectures and live patient courses.

"Most dental aesthetics plans and therapeutic plans include Botox and dermal fillers," he concluded. "The controversy whether dentists can properly do Botox and dermal filler procedures with great aesthetic and therapeutic outcomes is in the past."